Healthcare Provider Details

I. General information

NPI: 1548212707
Provider Name (Legal Business Name): GGNSC CROSSETT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 WATERWELL RD
CROSSETT AR
71635-4152
US

IV. Provider business mailing address

1101 WATERWELL RD
CROSSETT AR
71635-4152
US

V. Phone/Fax

Practice location:
  • Phone: 870-364-5721
  • Fax: 870-364-7680
Mailing address:
  • Phone: 870-364-5721
  • Fax: 870-364-7680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number810
License Number StateAR

VIII. Authorized Official

Name: HOLLY A. RASMUSSEN-JONES
Title or Position: SECRETARY
Credential:
Phone: 479-201-4835